BC Pelvic Pain Flashcards
What are three causes of pregnancy related pelvic pain?
ectopic, molar, abruption
What are three structural areas that are associated with gyne pelvic pain
Ovary, tube, uterus
What are causes of ovarian originating pelvic pain?
ruptured cyst, torsion
What are causes of tubal originating pelvic pain?
PID, endometriosis
What are causes of uterus originating pelvic pain?
leiomyoma, endometriosis
What are non gyne causes of pelvic pain
Dysmenorrhea, ovulation pain, dyspareunia
What are systemic issues that can cause pelvic pain?
Uro (interstitial cystitis, renal colic), MSK (fibromyalgia, GI (IBS/IBD< diverticulitis, hernias)
What are non medical reasons for pelvic pain
mental health, depression, somatiziation, sexual, physical, psychological abuse
What is the minimum diagnostic criteria for PID
Lower abdo tenderness, adnexal tenderness, Cervical motion tenderness
How does PID present
Lower abdo tenderness worsening over days, cervical discharge
What is the gold standard for PID dx?
Laparoscopy demonstrating abN consistent (fallopian tube erythema, discharge)
What is a complication of PID?
Fitz Hugh Curtis Syndrome (inflammation of the liver capsule)
What is the best way to dx herpes simplex?
viral culture (if lesions are present)
Vaginal swabs for saline wet prep are testing for what?
trichomonas?
When do you admit a PID case?
surgical emergency cannot be excluded (appendicitis), pregnancy, no response to oral abx therapy, unable to follow or tolerate outpt oral regimen, severely ill, tubo ovarian abscess, youth/adolescent (if compliance is an issue), HIV +ve
What are the sexually transmitted causes of PID
Chlamydia trachomatis, neisseria, gonorrhea, viruses and protozoa (rare) (HSV, Trichomonas vaginalis)
does BV cause PID?
Yes (Gardnerella vaginalis)
how do u tx PID as an inpatient
Foxy Doxy (cefoxitin, doxycylin)
What are sx of toxic shock
Fever, rash, sore throat, mods, staph aureus exotoxin
what is pelvic cellulitis?
common post hysterectomy, vaginal vault, erythema, induration, tenderness.
A 20 year old woman presents to the ER with right lower quadrant pain. After establishing that the patient is stable, what is the most important test to order?
a) Urinalysis
b) Amylase
c) Liver function tests
d) Arterial blood gases
e) Serum β-hCG
serum beta hcg
A previously healthy 42 yo woman comes to clinic b/c of a 6-mo hx of increasingly heavy menstrual periods and a 2-mo hx of prolonged flow. Exam reveals a slightly enlarged, smooth, freely mobile uterus. Abdominal US shows a 4-cm leiomyoma uteri. Which of the following is the most likely type of leiomyoma?
a) Parasitic
b) Subserosal
c) Submucosal
d) Pedunculated
e) Intramural
Submucosal
A 23y.o. female presents to the ED with RLQ abdominal pain. Pain began suddenly, is sharp, has worsened over the past 4 hours and is associated with nausea and vomiting. She denies any fever, diarrhea, urinary symptoms, vaginal discharge or bleeding. LMP was 3 weeks ago and she is in an OCP. HR 115bpm, other vitals are stable.
Ddx
a) Ovarian cyst torsion
b) Ruptured or hemorrhagic ovarian cyst
c) Ectopic pregnancy
d) PID
e) Appendicitis
f) UTI
g) Renal colic
h) Degenerating leiomyoma
A 21 year old woman has had persistent superficial
dyspareunia for the past year. She is otherwise
asymptomatic. Vaginal cultures have been negative
on 3 occasions. On examination, the skin located
just exterior to the hymen is slightly reddened and
painful to the touch. Which one of the following is
the most likely diagnosis?
a) Persistent herpes infection
b) Lichen sclerosus
c) Human papillomavirus infection
d) Vestibulitis
e) Allergic vulvitis
d)Vestibulitis
What are the sx of interstitial cystitis
UTI sx (pain, pressure, discomfort) Can last 6wk
